Group therapy

Introduction  Group therapy or group psycho therapy is a less time consuming procedure in which usually 8-10 people can be treated at one time.  Joseph Pratt first used this in 1905.

Group therapy may be utilize psycho analytic, supportive, transactional or behavioral approaches. The sessions are held once or twice a week, with each session lasting 1-2 hours, the patients usually sit in a circle.

Definition Group therapy or group psychotherapy is a form of treatment in which carefully selected, emotionally ill patients are placed into group, guided by a trained therapist for the purpose of changing the maladaptive behavior of the individual member.

Purposes  To intervene in psychopathology  To reveal, examine and resolve distortions in interpersonal relationships  To improve the skill of relating to others  To learn coping styles

Therapeutic functions of Group therapy (Yalom)  Imparting of information  Instillation of hope  Universality  Altruism  Corrective recapitulation of the Primary Family Group.

Contd…

Types of group therapy 1. According to size A. Small B. Large 2. According to diagnosis of clients A. Homogeneous group B. Heterogeneous group

3. According to nature of group A. Primary group B. Secondary group 4. According to purpose A. Psychoanalytic group therapy B. Transactional Analysis C. Rational- emotive therapy

D. Gestalt therapy E. Interpersonal Group therapy F. Psycho drama group G. Encounter Groups H. T- groups I. Community support groups J. Marathon groups

Psychoanalytic group psychotherapy Group communication is focused on the three levels of unconscious, semiconscious and conscious material. The group focuses on interpretation of dreams, free association, and other latent content product in the group. The therapist turns these experiences into conscious, healthy learning experiences for the client.

Transactional analysis The three ego stages of the individual- the parent, the child, the adult-are examined in TA group.

Rational emotive therapy It aims to maximize a person’s rational thinking

Gestalt therapy It emphasizes on self- expression, self- exploration and self awareness in the patient. Clients and therapist focus on every day problems and try to solve them

Interpersonal group therapy

Psychodrama group During psychodrama, the client produces a topic to be explored. The therapist directs the subject through role playing of scenes related to the topic and incorporates the use of therapeutic ideas in the action. A catharsis occurs for the subject and also for the audience.

Encounter groups It aims at bringing personal change as a result of deeply felt experiences.

T- groups  The goal is to verify experimentally the T-group method. This involves the study of group norms, roles, communication distortions, and the effect of authority on behavior patterns personality and coping mechanisms.  Group members receive feedback by exposing themselves to others in the group, and they also experiment with new and more productive behavior.

Community support groups  It provides identification, clarification, understanding, role modeling, feeling of togetherness, and group cohesion.  They help individual member from being lonely and depressed.  They help the members decrease levels of stress and increase levels of self-acceptance. The members develop new or more effective patterns of behavior.

Marathon groups  The term marathon group refers to the amount of concentrated time the participants spend together as a group. These sessions may last from 12 hrs to 2,3 or more days, allowing short periods away from the group for sleeping and eating.  These groups have a clearly stated goal of personal change or growth of the participants.  Size of group 8-10 members, duration of each session is 1-2 hrs, frequently everyday or 3 days in a week.

Stages of group therapy Initial stage  Involvement among members is superficial  Members are becoming acquainted with each other  They search for similarity between themselves and other group members  Some amount of structuring of group norms, roles and responsibilities take place

Working Stage  Members get into “Work” accomplished  Freely approach each other, discuss their problems and attempt to solve their problems.  Conflict and cooperation surface during the work group.

Criteria of patients to be included in group therapy  Ability to communicate  Willingness to share his problems with others  Motivation to change  Patients with authority anxiety  Patients using defense mechanism of projections, repression, denial, suppression, transference reactions.

Factors contributing to group therapy  Faith in the treatment procedure  Universality of problems  Direct guidance for the problem  Altruism  Development of socializing skills

 Imitative behavior  Catharsis  Conflict resolution  Acceptance of reality  Group cohesiveness  Interpersonal learning

Therapeutic interventions/techniques in the group therapy  Approval  Acceptance  Clarification  Exploration  Identification  Interpretation  Information giving

 Encouraging expression of feelings or ideas  Reassurance  Support  Understanding  Reflection  Listening  Teaching  silence

 Structuring  Limit setting  Transference and counter transference  Themes

Advantages of group therapy o Cost effective o Decreases the feeling of isolation, uniqueness o Enhances problem sharing o Opportunity to explore specific styles of communication in a safe atmosphere o Lear multiple ways of solving problems from other group members o Learn socialization skills o Group provides for its members understanding, confrontation and identification with more than one individual.

Disadvantages  Individual privacy is destroyed  Resistance and reluctant to change  Therapist at times dominates in the therapy session

Nurses roles in group therapy Group task role Aim is to identify group problems and select methods to solve those problems. Seeks clarification Suggests or proposes new ideas Asks for opinions or values pertinent to what the group is undertaking Gives information, offers facts or generalization0

Gives his/her opinion by stating his/her ideas and values about group suggestions Elaborates the meaning of suggestions offered to the group Coordinates shows or clarifies how ideas can work Orients the group on target by defining where the group is in relationship to its goal. Evaluates the accomplishment of the group in relation to its task Motivates the group to greater productivity Records the productive discussions

Group building and maintenance roles Aim- to strength, regulate and perpetuate the group members to function as whole group Encourages and accepts the contribution of others Reconciles differences between group members Admits his/others error to maintain group harmony Keeps communication open and provides encouraging remarks Sets group goals and evaluate the group functioning Observe group discussion, gives feed back and interprets

Individual role Aim: meet the needs of the group member and not the group. This hampers group functioning, we need to be aware of Expresses aggression, which deflates the status of individual and group accomplishment Resists progress by arguing or disagreeing beyond reason Calls attention to himself/ herself through boasting and pointing out his achievements.

Gives self confession by expressing his/her feelings and ideology not related to the group, but uses the group audience Demonstrates his/her lack of involvement Asserts his or her authority and superiority in manipulating the group or certain members of the group. Seeks help or tries to elicit sympathy from the group Tries to have his/her own biases and prejudices. Individually oriented behavior

Some basic roles of nurses Determine setting and size of the group Choose frequency and length of group sessions Select a therapist/ co therapist for group Formulate policy on group therapy with other therapeutic modalities Formulating appropriate goals

Selecting patients who can perform the group Preparing patients for group therapy Build the culture of the group explicitly and implicitly Explaining the group members to maintain the confidentiality of the group activities. Identify and resolve the petty problems of the group

Fix up time for the subsequent sessions Maintain attendance group members Obtain written informed consent from the group members Maintain strict discipline and confidentiality Document all the sessions Monitor the group members behavioral changes